<html>
<head>
</head>
<body>

<wicket:panel>
<div class="ufb clearfix">
	<h3 style="margin:5px; color:#FFCC00;">Send Feedback</h3>
	<form wicket:id="formFFP">
		<div wicket:id="feedback" style="padding:3px; color:#6C3306; font-weight:bold; background-color:#FFCC00;">Feedback goes here!</div>
    	<dl>
        	<dt><strong>Your Name</strong></dt>
            <dd> 
            	<input wicket:id="nameFFP" type="text" style="width:200px;" />
            </dd>
            
            <dt><strong>Email</strong></dt>
            <dd>
            	<input wicket:id="emailFFP" type="text" style="width:200px;" />
            </dd>
            
            <dt><strong>Report Type</strong></dt>
            <dd>
            	<select  wicket:id="typeFFP" style="width:200px;">
                	<option>Bug</option>
                    <option>Suggestion</option>
                    <option>Feature</option>
                    <option>Feedback</option>
            	</select>
            </dd>
            <dt><strong>Description</strong></dt>
            <dd>
            	<textarea wicket:id="descFFP" style="width:400px; height:150px; overflow:auto;"></textarea>
            </dd>
            <dt></dt>
            <dd>
            	<button wicket:id="submitForm" type="submit" class="es-button ui-state-default ui-corner-all">Send Report</button>
            </dd>
        </dl>
    </form>
	<div>
    	<span style="font-style:italic;margin-left:10px;color:#666;">Your response will be kept confidential and we promise not to spam you.</span>
    </div>
</div>
</wicket:panel>

</body>
</html>